Establishing an Integrated Behavioral Health Program and Practicum Site in a Community-Based Primary Care Center

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Establishing an Integrated Behavioral Health Program

and Practicum Site in a Community-Based Primary Care

Center

Christina S. Lee, Ph.D.

Dept. of Applied Psychology

Northeastern University, Boston, MA

IBH Program Director

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2

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Integration

Primary Care

• Dan Simpson, M.D.

• Tom Sterne, M.D.

• Deb Clifford, R.N.

Behavioral Health

• Laurie Goldman, Psy.D.,

R.N.

• Ray Walden, L.I.C.S.W.

• Alexander Young, Psy.D.

• Rick Silva, Pharm.D.

• Interns:

– Heather Bennett

– Atsushi Matsumoto

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March, 2013 Integrated Behavioral Health (IBH) Program planning begins.

April 20, 2013 Proposal for the IBH Program and Psych Intern training submitted by Dr. Lee to the SECHC. IBH Intern training objective is to pilot IBH training curricula for SECHC psychology interns.

May, 2013 The curriculum for the IBH Program and the IBH Seminar series is developed.

July 1, 2013 Focus group moderated by Dr. Lee with providers (n=15; 4 Adult medicine, 2 Family medicine, 2 Pediatrics, 6 Ob/Gyn, 1 Hass Center) on perceptions of behavioral health before IBH. Suggestions used to improve awareness, training needs, and communication regarding the IBH Program and intern training.

July 15, 2013 IBH Program meeting with interdisciplinary providers and IBH interns

Discussed IBH referral process between provider and consultant, triage process of linking out to care

Sept 6, 2013 First IBH intern class orientation at SECHC.

Sept 10, 2013 Introduction of IBH program to SECHC clinicians. The “Roll-Out” presentation. The purpose of IBH and referral process is presented. Survey and focus group findings presented.

Sept 19, 2013 IBH Seminar Series begins and IBH interns begin shadowing providers

Oct 1, 2013 IBH begins seeing patients

Nov 17, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns

Dec 12, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns

IBH Planning

IBH intern seminars

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Timeline Year 1,

cont.

Jan 25, 2014

Breakfast: IBH Program meeting with

interdisciplinary providers and IBH

interns. Providers give positive feedback

on IBH. Discussion on how to improve

referral system, and advantage of

in-person referral

March 3, 2014 IBH referral process reviewed by Admin

team. Preliminary IBH data reviewed.

New patient screening tools discussed

June 3, 2014

IBH manual drafted

August 4, 2014

Procedures to gather IBH patient

satisfaction survey reviewed. Focus

group with providers planned.

IBH coordination

and Intern

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Integrated Health Seminars 2013-2014

1. Functional Assessments and the 5As

2. Integrated behavioral health: Anxiety and depression

3. Medical literacy

4. Writing case notes for integrated care

5. Substance use assessments

6. Crisis management

7. Adult psychopharmacology in mental health, Part I

8. Negotiating behavior change in health behaviors

9. Adult psychopharmacology in mental health Part II

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Integrated Behavioral Health Coverage Schedule November 2013

Location: SECHC PAATHS Office 2

nd

Flr

IBH Consultant Contact Number: 857-301-0154

Common Reasons for Referral: Stress, Insomnia, Anxiety/Fears, Chronic Pain, Mild Depression, Headache, Anger,

Relationship Problems, Grief or Bereavement, Low Back Pain, Diet (weight loss, dietary adherence problems), Tobacco Use, Exercise, Chronic Illness Management: Diabetes, GI Problems, COPD, Medication Adherence

Services:Consultation (30 minutes) for assessment and behavioral health treatment planning, recommendations, and interventions

Purpose: To help patients develop practical knowledge and skills to promote and improve physical and emotional health

Contact Procedure: Intern provides primary coverage - CONTACT FIRST. Staff provides back-up coverage when necessary

Referral Procedure: Complete IBH Referral Form found in EMR under Letters tab, and (when possible) flag IBH consultant

on call. Introduce patient to IBH consultant and provide IBH consultant with any relevant patient information  General Hours of IBH Coverage: 9:00 - 12:00 (AM) and 1:00 – 4:00 (PM)

Monday:

AM

INTERN- Heather Bennett

CONTACT: 857-301-0154

STAFF- Richy Villa

CONTACT: ext. 7671

PM

INTERN- Heather Bennett

CONTACT: 857-301-0154

STAFF- Richy Villa

CONTACT: ext. 7671

*Indicates individual is Spanish speaking

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Date: ________________

Patient Name: _________________________ DOB: _________________________

Preferred Language: [ ] English

[ ] Spanish [ ] Other: _______________

Referring Provider: ____________________________

Referral Type:

[ ] Routine [ ] Urgent-seen in 2-3 days

[ ] Emergent

Reason for referral:

[ ] Anxiety

[ ] Grief

[ ] Depression

[ ] Recent Psych Hospitalization

[ ] Smoking Cessation

[ ] ADHD/ADD Evaluation

[ ] Diagnostic Evaluation, e.g. Bipolar, ADD, other

[ ] Substance Abuse

[ ] Other: _____________________________________________________________

Referral to:

[ ] Pharm D: For comprehensive medication management for anxiety, depression, other psychiatric conditions, access to

Specialty BH 3

rd

floor

[ ] CAMI Study: Alcohol use disorders, substance use

[ ] Integrated BH Consultant: For evaluation and short term counseling; e.g. anxiety, depression, relaxation training,

grief, sleep hygiene, smoking cessation, substance use

[ ] Specialty Behavioral Health Service 3

rd

floor

[ ] PLEASE CALL PATIENT: Patient could not see clinician today, but wished to be called

Telephone number (confirmed with patient): ________________________________

NOTE:

IBH will usually see patient up to 3 visits and will refer to Specialty Behavioral Health, 3

rd

floor, if patient needs long term

management.

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Importance of in-person referral

Referral

Type

Pts seen

Remaining to be

seen

Total

Paper

52 (36%)

93

145

Verbal

33 (89%)

4

37

Flag

2

1

3

Paper &

Verbal

4

0

4

Total

91

98

189

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1. How would you rate the ease of making an initial appointment with the Health and Wellness consultant?

(1) Poor (2) Fair (3) Good (4) Excellent

2. How would you rate the ease of making a follow-up appointment with the Health and Wellness consultant?

(1) Poor (2) Fair (3) Good (4) Excellent

3. Did you get the kind of help you wanted from the Health and Wellness consultant?

(1) No, definitely not (2) No, not really (3) Yes, generally (4) yes definitely

4. How satisfied are you with the help you received from the Health and Wellness consultant?

(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied

5. If a friend were in need of similar help, would you recommend the health and wellness consultant to him or her?

(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely

6. Has the help you received from the Health and Wellness consultant helped you to deal more effectively with your concerns?

(1) No, seemed to make worse (2) No, didn’t really help (3) No, didn’t really help (4) Yes, a great deal

7. In an overall, general sense, how satisfied are you with the help you have received from the Health and Wellness consultant?

(1) Quite dissatisfied (2) Indifferent or mildly dissatisfied (3) Mostly satisfied (4) Very satisfied

8. If you were to seek help again, would you come back to see a health and wellness consultant?

(1) No, definitely not (2) No, I don’t think so (3) Yes, I think so (4) Yes, definitely

Patient Satisfaction Survey*

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Student education and training

IBH Manual drafted

Seminars planned

Supervision issues and coverage

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Counseling PhD Student participation and

development

IBH Internship Track at SECHC

6 Phd Level trainees

IBH researchers:

Welcome to our new

Northeastern Counseling Ph.D students. Check them

out on our website!

Janelle Alabiso, M.A.

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Thank You to the South End Community

Health Center, and to the Psychology

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Christina S. Lee, Ph.D.

Dept. of Applied Psychology

Northeastern University, Boston, MA

Chr.lee@neu.edu

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